Venous Thromboembolism and Foot and Ankle Surgery

Abstract

Significant patient morbidity and mortality is associated with the development of venous thromboembolism (VTE) following orthopedic surgery. The majority of the literature supports proper prophylaxis following major orthopedic surgery involving hip and knee procedures. Foot and ankle surgery, however, is starkly contrasted because of the lack of recommendations. This article provides a comprehensive overview of the risk factors and incidence of VTE in foot and ankle surgery while also outlining the newest literature guidelines for prophylaxis.

Venous Thromboembolism in Podiatric Foot and Ankle Surgery

“…25 However, we were able to assess other factors such as estrogen therapy, which is recognized in the literature as a risk factor for VTE. 14,23,28,29 Our current study did not find a significant relationship between hormone replacement therapy and TP administration, which is consistent with the ANZWP guidelines 6 that recognise oestrogen therapy as an additional rather than a high risk factor for the development of postoperative VTE.…”

“…The foot and ankle literature acknowledges obesity as a risk factor for VTE. 28,29 This relationship may be due to increased levels of prothrombotic factors, along with decreased levels of antithrombin and fibrinolytic activity. 25 However, we were able to assess other factors such as estrogen therapy, which is recognized in the literature as a risk factor for VTE.…”

Impact of Knee Scooter Flexion Position on Venous Flow Rate

“…2,7,8 Prospective ultrasound screening for DVT paints a more concerning picture, with up to 38.5% of patients developing a clinically detectable DVT. 8,11 The risk of thrombosis was shown to be higher in traumatic cases, including ankle fractures and Achilles rupture, compared to elective cases such as first metatarsal osteotomy and hindfoot fusion. 10,13 There is likely a temporal association with DVT formation and stasis that we were unable to investigate in this study, but it could apply to patients using the scooter for extended periods during the day.…”

“…2,7,8 Prospective ultrasound screening for DVT paints a more concerning picture, with up to 38.5% of patients developing a clinically detectable DVT. 8,11 The risk of thrombosis was shown to be higher in traumatic cases, including ankle fractures and Achilles rupture, compared to elective cases such as first metatarsal osteotomy and hindfoot fusion. 10,13…”

Prevalence of Deep Vein Thrombosis in Low-Risk Patients After Elective Foot and Ankle Surgery

“…The evidence regarding the prevalence of deep vein thrombosis (DVT) after foot and ankle surgery is conflicted. 2,6,11,14,26,35,36 The incidence of DVT in foot and ankle surgery has been reported between 0.22% and 8.46%, 32 with 0.15% developing into nonfatal emboli. 6,11,26,36 A systematic review by Mangawani et al 22 and a meta-analysis by Calder et al 3 stated that the overall incidence of DVT in foot and ankle surgery is low; however, the studies that met their criteria for inclusion are an assortment of retrospective studies that include the nonoperative management of trauma, surgery to all parts of the foot or ankle relying on the clinical diagnosis of DVT as well as a retrospective review of charts based on a coding system.…”